Severe obesity and metabolic syndrome are associated with higher complications following endoscopic lumbar decompression.

BACKGROUND: Endoscopic lumbar decompression is increasingly used to treat lumbar spinal stenosis, but the impact of obesity on short-term postoperative outcomes remains unclear. This study evaluated the association of BMI and metabolic syndrome with 30-day complications and reoperation following endoscopic lumbar decompression. METHODS: A national database was queried for patients undergoing endoscopic lumbar decompression between 2017-2023. Patients were stratified by BMI category (normal, overweight [25 to <30], class I obesity [30 to <35], class II/III obesity [≥35]). Metabolic syndrome was defined as BMI ≥ 30 with concurrent diabetes mellitus and hypertension. Outcomes included 30-day readmission, reoperation, and composite morbidity, including surgical site infection (SSI), urinary tract infection (UTI), transfusion, pneumonia, or sepsis. Categorical variables were compared using chi-square or Fisher exact tests; continuous variables were analyzed using one-way ANOVA. RESULTS: A total of 398 patients were included (normal n = 70, overweight n = 116, class I obesity n = 137, class II/III obesity n = 75). BMI ≥ 30 was not associated with differences in 30-day readmission, reoperation, or overall morbidity. In contrast, BMI ≥ 35 was associated with higher 30-day morbidity (6.7% vs 1.2%, p = 0.014), higher SSI (4.0% vs 0.6%, p = 0.048), and higher UTI rates (2.7% vs 0.3%, p = 0.033). Metabolic syndrome was associated with increased readmission (9.7% vs 2.7%, p = 0.037) and morbidity (9.7% vs 1.6%, p = 0.026). CONCLUSIONS: Endoscopic lumbar decompression demonstrated low overall 30-day event rates across BMI strata. Class I obesity was not associated with higher short-term adverse event rates; however, exploratory threshold analyses identified higher morbidity among patients with BMI ≥ 35 and metabolic syndrome, driven primarily by wound complications and UTI.